Healthcare Provider Details

I. General information

NPI: 1326477571
Provider Name (Legal Business Name): DANITASTVRAIN STVRAIN CAC III
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4507
US

IV. Provider business mailing address

812 NOB HILL TRL
FRANKTOWN CO
80116-7917
US

V. Phone/Fax

Practice location:
  • Phone: 303-602-2716
  • Fax:
Mailing address:
  • Phone: 720-225-8172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0007215
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: